TRANSFORMING THE CARDS DEALT:
ADVERSITY AND RESILIENCY
FROM THEORY TO PRACTICE
Presented by:
Dr. Allison Sampson-Jackson, LCSW, LICSW, CSOTP
Making a Treatment or Case Plan
TRAUMA AND RESILIENCE INTERVIEW
Setting the Stage
Checking in
Having something available for youth to do with their hands (ex: crayons, stress balls,
markers, etc.)
Ground rules and setting expectations
• What I am going to be asking about?
‒ Skills you have, bad chapters in life, good chapters in life
• Why am I asking?
• “Telling” if gives permission or if someone is in danger
• Who is going to see this
Book chapter titles, not book contents
SUDS scale (1-10)
Safety signal if beginning to feel too overwhelmed
• Ex: Hand Signal, “I don’t want to answer that”
GROUNDING TECHNIQUES
Grounding and Checking In
SAMHSA Grounding Techniques
Exhibit 1.4-1: Grounding Techniques
http://store.samhsa.gov/product/TIP-57-Trauma-Informed-Care-in-Behavioral-Health-Services/SMA144816 p.119
Grounding techniques are important skills for assessors and all other behavioral health
service providers who interact with traumatized clients (e.g., nurses, security,
administrators, clinicians). Even if you do not directly conduct therapy, knowledge of
grounding can help you defuse an escalating situation or calm a client who is triggered by
the assessment process.
Grounding strategies help a person who is overwhelmed by memories or strong emotions
or is dissociating; they help the person become aware of the here and now. A useful
metaphor is the experience of walking out of a movie theater. When the person dissociates
or has a flashback, it’s like watching a mental movie; grounding techniques help him or her
step out of the movie theater into the daylight and the present environment. The client’s
task is not only to hold on to moments from the past, but also to acknowledge that what
he or she was experiencing is from the past.
Try the following techniques:
Source: Melnick & Bassuk, 2000.
Ask the client to state
what he or she observes.
Guide the client through this exercise by using statements like,
“You seem to feel very scared/angry right now. You’re probably
feeling things related to what happened in the past. Now, you’re in
a safe situation. Let’s try to stay in the present. Take a slow deep
breath, relax your shoulders, put your feet on the floor; let’s talk
about what day and time it is, notice what’s on the wall, etc. What
else can you do to feel okay in your body right now?”
Source: Melnick & Bassuk, 2000.
Help the client
decrease the intensity of affect.
“Emotion dial”: A client imagines turning down the volume on his or her
emotions. •Clenching fists can move the energy of an emotion into fists,
which the client can then release. • Guided imagery can be used to
visualize a safe place. •Distraction. • Use strengths-based questions (e.g.,
“How did you survive?” or “What strengths did you possess to survive the
trauma?”).
Source: Melnick & Bassuk, 2000.
Distract the client from
unbearable emotional states.
Have the client focus on the external environment
(e.g., name red objects in the room). • Ask the client
to focus on recent and future events (e.g., “to do” list
for the day). • Help the client use self-talk to remind
himself or herself of current safety. • Use distractions,
such as counting, to return the focus to current
reality. • Somatosensory techniques (toe-wiggling,
touching a chair) can remind clients of current reality.
Source: Melnick & Bassuk, 2000.
Ask the client to use
breathing techniques.
Ask the client to inhale through the nose and exhale through the mouth.
• Have the client place his or her hands on his or her abdomen and then
watch the hands go up and down while the belly expands and contracts.
Source: Melnick & Bassuk, 2000.
OPENING WITH RESILIENCE
Opening with Resilience
Show the resilience list
Highlight 42 resilience factors vs. 10 adversity factors
Normalize:
• 50% of youth will have at least one ACE
• 70% of adults will have a least one ACE
Resilience Skills
Showing empathy
Critical thinking skills
Helping appreciate cultural & ethnic heritage
Sense of belonging
Learning to accept help
Hope
Trust
Sense of Belonging
Letting Child Know you are Available for Help
Resilience Skills
Learning Responsibility
Teach Self Discipline
Establish Consequences
Model Problem Solving
Sharing Something Important
Family Meetings
Clear Rules and Expectations
Help a Child Learn to Express Feelings
Accept Ownership for Behavior
Resilience Skills
Work as a team
Learn to show appreciation
Master a Skill
Assign a Responsibility
Sense Triggers that create negative behavior
Develop Communication Skills
Helping a Friend
Allowing Experience of Success or Failure
Resilience Skills
Respect ability to make decisions
Model appropriate behavior
Help child develop problem solving skills
Learning to ask for help
Acknowledge when you are wrong
Learn to self advocate
Give back to community
Giving a choice
Ability to Calm Self
Resilience Skills
Verbally say “I love you”
Express Feelings
Experience Success
Develop Friendships
Develop Self Esteem
Attach to Caring Adult
Learn to Solve Problems
Talk to me about your skills
Get them to share 2-3 skills they have that they see on the table with the cards
Give a story that they used one of those skills in
Bad Chapter Titles, not Book Contents
TALKING ABOUT THE TOUGH STUFF
Bad Chapter Titles
Note that the transition is going to happen now to the “bad” chapter titles
Present the ACEs information
Offer options
• Can be asked the questions
• Can read the questions
• Can take listen to a recording of the questions
First give the number
Identify events that have happened
Remember the ground rules
Resilience and ACEs game
Bread meat Bread
Pick an ACE you experienced
Pick 2-3 Resilience Skills/Cards you want to build
For every adversity, there are resilient skills you can build
http://resiliencetrumpsaces.org
UNDERSTANDING OUR
COPING STYLES
Behavior Wheel
When tough stuff happens ….
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Your body and brain change to cope
You choose coping skills that meet your needs then
Sometimes these coping skills help in some ways and cause big problems in other ways
These coping skills can be bad for our wellbeing
We want to look at the coping behaviors that may be causing you a hard time
Think abou the needs behind those coping behaviors
And figure out are there other ways you can practice coping that are more healthy
We want to offload the negative coping skills and increase the positive skills
Interviewing Skills
NORMALIZING
Rationale: Normalizing is intended to communicate to clients that having
difficulties while changing is not uncommon, that they are not alone in their
experience, or in their ambivalence about changing. Normalizing is not intended
to make clients feel comfortable with not changing; rather it is to help them
understand that many people experience difficulty changing.
Examples of Normalizing
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“A lot of people are concerned about changing their [insert risky/problem behavior].”
“Most people report both good and less good things about their [insert risky/problem
behavior].”
“Many people report feeling like you do. They want to change their [insert risky/problem
behavior], but find it difficult.”
“That is not unusual, many people report having made several previous quit attempts.”
“A lot of people are concerned about gaining weight when quitting.”
Region X ACE Planning Team (2015) NEAR@Home:
Addressing ACEs in Home Visiting by Asking, Listening and Accepting.
Washington: Region X ACE Planning Team.
Retrieved from https://thrivewa.org/nearhome-toolkit-guided-process-talk-trauma-resilience-homevisiting/
Behavior Wheel Example
Attention, fills
something, releasing
anxiety, self soothing
Behavior Wheel
Control
Release of anxiety/aggression
Defense mechanism – using it
as a barrier to keep people at a
distance
• Self mutilation
• Homicidal ideation
• Aggressive behavior
Gives her release,
she get things off
her chest
A safe way of getting a
message across, raising
red flags to dig deeper,
getting everyone’s
attention
Gets her attention
because she’s
making poor
decisions, at least
someone is paying
attention to her
Process of Building a Behavior Wheel
Interview your client and
build a behavior wheel with them
Now with the unhealthy behaviors
Again with new behaviors they can select
Closing with “Good” Chapter Titles
Talk about the best things that have ever happened you
Make the list of good things
• Time you felt happy
• Time you felt excited
• Supportive Adult Story
If possible get the age and SUD scale
MAKING A PLAN
Making a Plan
Look at the table in the Trauma/Resilience Case Planning Tool
What Resilience Skills/Replacement Coping Strategies does your client want to build based on the
ACEs/Resilience Table, their Behavior Wheel, and the “good stuff” they want to increase ?
What Resources will they need?
What is their time line?
Balancing
Expanding to Resilience
Helps case planning
Approach vs Avoidance Case Planning Goals
Helps know services and activities to link to
Balancing
HOW COULD THIS LOOK IN TREATMENT
PLANNING
CASE/TREATMENT PLAN EXAMPLES
Resiliency Toolkit – IOWA
http://www.iowaaces360.org/resiliency-toolkit.html
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Be a F.O.R.S.E. in your community
Focus
On
Resilience &
Social-Emotional
(competence)
Image by Lincoln High student Brendon Gilman
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Confidentiality Statement
By receipt of this presentation, each recipient agrees that the information contained herein will be kept
confidential and that the information will not be photocopied, reproduced, or distributed to or disclosed to others
at any time without the prior written consent of Magellan Health, Inc.
The information contained in this presentation is intended for educational purposes only and is not intended to
define a standard of care or exclusive course of treatment, nor be a substitute for treatment.
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Thanks